Vacuum-assisted delivery

The literature seems to allow certain general conclusions regarding the choice of instrument for assisted vaginal delivery. Both forceps and vacuum extraction offer certain advantages and drawbacks. Forceps are more difficult to apply, more prone to potentially significant facial injuries, require generally better maternal analgesia, and are associated with increased maternal soft tissue trauma. Vacuum extractors in general are easier to apply, are more likely to result in scalp trauma, and may be associated with increased rates of intracranial trauma. It seems likely that factors particular to each patient may play a significant role in the genesis of delivery associated with maternal and neonatal morbidity. Because of the ease of application, vacuum extractors may be used potentially in circumstances in which forceps assistance would not be attempted, allowing an operator of average experience to perform rotational deliveries. The use of vacuum extraction does appear to decrease the incidence of cesarean section in delivery populations. Given the apparent association between difficult assisted deliveries and increased neonatal morbidity, it is incumbent on the operator to attempt delivery only when vaginal delivery seems to be a safe option. Furthermore, the operator in such circumstances must be willing to reassess the attempt if initial attempts are not met with success. The minimal rates of significant intracranial injury associated with vacuum extraction in randomized studies of the method demonstrate the relative safety of the vacuum extraction when used judiciously. The ultimate choice of the route of delivery and method of assisted delivery should reflect a consideration of the fetal station, presentation, and maternal and fetal circumstances. It is hoped that further investigations in this area may clarify some of the issues discussed in this article.